G-DEE (Guideline Document Engineering Environment)

 

    A text analysis environment dedicated to the study of clinical guidelines. It supports multiple document processing functions including the automatic recognition of recommendations using shallow NLP techniques to recognize deontic expressions which are most likely to correspond to recommendations.

Keywords: clinical guidelines, XML, document engineering, markup languages.


DESCRIPTION

G-DEE incorporates text processing functions to support encoding through a first level of automatic structuring. It also supports various document analysis features, some dealing with specific text display, and others triggering text analysis functions to extract knowledge or information (e.g. in a rule-based format, GEM). The analyzed expressions are structured using specific mark-ups, which supports hypermedia presentation of the recommendations.
Central to our approach is the fact that automatic content processing should support document structuring by generating mark-ups each time specific linguistic markers are recognized (for instance linguistic markers signaling recommendations). Recommendations are the essence knowledge of the clinical guidelines and are taken into account to elaborate knowledge bases and decision support systems. Clinical guidelines are naturally structured through the occurrence of specific linguistic expressions, known as “deontic operators”. These operators manifest themselves through such verbs as “pouvoir” (“to be allowed to or may”), “devoir” (“should or ought to”), “interdire” (“to forbid”) and correspond to traditional deontic modalities: permission, obligation and prohibition. We have developed an ad hoc parsing technology based on Finite-State Automata which parses the document and generates mark-ups corresponding to deontic operators and their scopes. The marked-up document can subsequently be the object of various XSL-based transformations.

The interface supports the selective processing of text fragments, which are analyzed for deontic operators (interface button 1) and marked-up accordingly (window B). The resulting marking-up can be validated interactively by the user (button 1 of the interface). In addition, G-DEE enables to automatically display contents of specific GEM elements, as well as deontic operators in window C. Window D displays decision rules automatically derived from the marked-up text, which can be used for knowledge extraction or analysis of text coherence.

The automatic processing component, which underlies the marking-up process, has been evaluated using two complete clinical guidelines (corresponding to over 300 recommendations). As a result, precision of marker identification varied between 88 and 98% and recall between 81 and 99%.

G-DEE was originally conceived as a research environment but has since been adopted as an experimental tool for assisting the guideline authoring process in the French National Authority for Health (HAS), and has been used to provide an independent analysis of guidelines structure.


DEMO

    DEMO G-DEE (1.35 M) .



RELATED PUBLICATIONS

PhD Thesis (In French). 6 September 2006.

Analyse informatique de Guides de Bonnes Pratiques (Computer Analysis of Clinical Guidelines). del


Book Chapters

1 Gersende Georg. Computerization of Clinical Guidelines: an Application of Medical Document Processing. In: BG Silverman, A Jain, A Ichalkaranje, LC Jain (Eds.). Intelligent Paradigms for Healthcare Enterprises Systems Thinking. Series: Studies in Fuzziness and Soft Computing, Springer-Verlag. 2005;184:1-30.

Papers in Refereed Journals

2 Gersende Georg, Isabelle Colombet, Pierre Durieux, Joël Ménard, Pierre Meneton. A Comparative Analysis of Four Clinical Guidelines for Hypertension Management. J Hum Hypertens advance online publication, August 7, 2008; doi:10.1038/jhh.2008.99
3 Gersende Georg, Brigitte Séroussi, Jacques Bouaud. Extending the GEM Model to Support Knowledge Extraction from Textual Guidelines. International Journal of Medical Informatics 2005;74(2-4):79-87.

Papers in Refereed Conference Proceedings

4 Gersende Georg, Marc Cavazza, Catherine Pelachaud. Visualizing the Importance of Medical Recommendations with Conversational Agents. In: H. Prendinger, J. Lester, and M. Ishizuka (Eds.), LNAI 5208. Proc. of 8th International Conference on Intelligent Virtual Agents (IVA 2008), September, 1-3. 2008, Tokyo, Japan. 380–393. download
5 Gersende Georg, Catherine Pelachaud, Marc Cavazza. Emotional Reading of Medical Texts Using Conversational Agents (Short Paper). In: Padgham, Parkes, Müller and Parsons (eds.), Proc. of 7th International Conference on Autonomous Agents and Multiagent Systems (AAMAS 2008), May, 12-16. 2008, Estoril, Portugal. 1285-1288. download
6 Gersende Georg, Marie-Christine Jaulent. A Document Engineering Environment for Clinical Guidelines. In: Peter R. King & Steven J. Simske. DocEng'07 - Proceedings of the 2007 ACM Symposium on Document Engineering. 28-31 August 2007, Winnipeg, Manitoba, Canada. ACM Press, New York NY, USA. 2007;:69-78. download
7 Gersende Georg, Marc Cavazza. Integrating Document-based and Knowledge-based Models for Clinical Guideline Analysis. In: R. Bellazzi, A. Abu-Hanna, J. Hunter (editors). Proceedings of 11th Conference on Artificial Intelligence in Medicine in Europe. ; 7-11 July 2007; Amsterdam, The Netherlands; Lecture Notes in Artificial Intelligence 4594, Springer-Verlag Berlin Heideberg; 2007;:421-430. download
8 Gersende Georg, Marie-Christine Jaulent. An Environment for Document Engineering of Clinical Guidelines. In: CP Friedman, editor. Proceedings of the American Medical Informatics Association; 22-26 October 2005; Washington, DC;2005;:276-280. download
9 Gersende Georg, Isabelle Colombet, Marie-Christine Jaulent. Structuring Clinical Guidelines through the Recognition of Deontic Operators. In: R Engelbrecht, editor. Proceedings of Medical Informatics Europe 2005; 28 August - 1 September 2005; Geneva, Switzerland; IOS Press Amsterdam. 2005;116:151-156. download
10 Gersende Georg, Brigitte Séroussi, Jacques Bouaud. Synthesis of Elementary Single-Disease Recommendations to Support Guideline-Based Therapeutic Decision for Complex Polypathological Patients. In: M Fieschi, editor. Proceedings of MEDINFO Symposium; 7-11 September 2004; San Francisco; 2004;:38-42. download
11 Gersende Georg, Brigitte Séroussi, Jacques Bouaud. Does GEM-Encoding Clinical Practice Guidelines Improve the Quality of Knowledge Bases? A Study with the Rule-Based Formalism. In: M Musen, editor. Proceedings of the American Medical Informatics Association; 8-12 November 2003; Washington, DC; 2003;:254-258. download
12 Gersende Georg, Brigitte Séroussi, Jacques Bouaud. Managing Theoretical Single-Disease Guideline Recommendations for Actual Multiple-Disease Patients. In: M Dojat, editor. Proceedings of 9th Conference on Artificial Intelligence in Medicine in Europe; 18-22 October 2003; Protaras, Cyprus; Lecture Notes in Artificial Intelligence 2780, Springer-Verlag Berlin Heideberg; 2003;:168-172. download
13 Gersende Georg, Brigitte Séroussi, Jacques Bouaud. Interpretative Framework of Chronic Disease Management to Guide Textual Guideline GEM-Encoding. In: R Baud, editor. Proceedings of Medical Informatics Europe; 4-7 May 2003; Saint-Malo, France; IOS Press Amsterdam. 2003;95:531-536. download
14 Gersende Georg, Brigitte Séroussi, Jacques Bouaud. Dérivation d'une base de connaissances à partir d'une instance GEM d'un guide de bonnes pratiques médicales textuel. In: R Dieng-Kuntz, editor. 14e journées francophones d'Ingénierie des Connaissances; 1-4 July 2003; Laval, France; Presses Universitaires de Grenoble; 2003;:51-66. In French. download
15 Gersende Georg, Brigitte Séroussi, Jacques Bouaud. Synthèse de recommandations établies par pathologie pour l'aide à la thérapeutique des patients polypathologiques. In: A. Harmel, R. Hajromdhane, M. Fieschi. Technologies de l'information et de la communication pour les pratiques médicales. Collection Informatique et Santé dirigée par P. Degoulet et M. Fieschi. Springer 2003;16:242-254. Comptes rendus des dixièmes Journées Françaises d'Informatique Médicale, 4-5 september 2003, Tunis, Tunisie. In French. download

Referred Abstracts

16 Gersende Georg, Marc Cavazza, Catherine Pelachaud. Exploring the Perception of Recommendations with Next-generation Multimedia Systems. G-I-N Conference 2008. Helsinki, Finland. 1-3 October 2008.
17 Gersende Georg, Isabelle Colombet, Pierre Durieux, Joël Ménard, Pierre Meneton. A Comparative Study of Four Clinical Guidelines for Hypertension Management Hypertension 2008. Berlin, Germany. 14-19 June 2008.

18 Gersende Georg, Anne-Françoise Pauchet-Traversat, Joëlle André-Vert, Christine Geffrier-d'Acremont. Integrating a document engineering environment into the French guidelines development process. G-I-N Conference 2007. Toronto, Ontario, Canada. 22-25 August 2007. download

19 Gersende Georg, Pierre Meneton, Isabelle Colombet, Pierre Durieux, Joël Ménard. A comparative study of international guidelines for the management of hypertension. G-I-N Conference 2007. Toronto, Ontario, Canada. 22-25 August 2007.download

Professional Magazines

20 Gersende Georg. L'informatique, une aide au développement des recommandations pour la pratique clinique. Le Mensuel de l'Université - No 15 - May 2007. In French.